[Question #2169] HPV clarifications - please help

46 months ago

Hi doctors, Thank you for your service. I have few questions on HPV if you could kindly help me, I believe in you both, its on my mind (quite heavily) hoping you could clarify as my questions based on Doc hooks answers to Question #2152)

1)Doctors, you both have been a long believer in HPV clearing after a few years, to a point that it usually doesn’t recur and unlikely to transmit to a partner after sometime from wart clearance ((3-6 months estimate). You believed that the DNA may persist but not the virus itself.  Has this opinion changed now? Or can we still go by the above statement?

2) My concern is transmission, not the persistence of viral DNA so are you saying now that, those infected with HPV, the virus itself are likely to be infected lifelong? Without overt warts is it transmittable after a year of no symptoms? Like the HSV1/HSV2 virus?

3)In between clearance and reemergence later on in life – is it safe to believe the virus is below detectable levels unlikely to be transmitted? Can these positive tests be triggered positive by DNA and not the virus itself?

4) Would you still say based on your experience and evidence, that once symptoms have cleared from HPV, and doesn’t recur within a reasonable few months, the virus is cleared to a point that it most likely won’t recur and unlikely to be transmittable, but there are only some occasional cases that has recently come about where HPV could emerge later ages in life (50 years and above), similar to shingles ?

5)I had white color flat patches that was initially diagnosed as warts, but I couldn’t rely on the expertise of the doctors (I am from Sri Lanka and the doctors aren’t as experienced as abroad), doctors doubted by genital warts diagnosis in UK, Warts appeared less than 5 weeks after possible exposure (I had sex unprotected twice with an status unknown female who bled after sex) – is this reason to doubt?

please help me by answers the above.

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome back to the Forum.  I'll do my best to help.  As you know, knowledge about HPV is moving forward and as we learn more about the infection, we periodically need to revise our considerations and understanding.  Reaching back historically, for decades warts were considered inconsequential until careful studies in the 80s demonstrated a link to cervical cancer and women.  Since then knowledge and understanding has continued to accrue but all in all, for most people HPV infections are mostly a nuisance which (now) can be largely prevented with a highly effective vaccine.  For that very small group of persons in whom the infection may progress to precancerous or, in a still smaller group, cancerous lesions, we have ever improving methods for detecting these changes and addressing them before they cause serious morbidity or even mortality.   You are clearly vigilant on this topic and I applaud that but I would also suggest that your vigilance should be tempered by remembering that while most people will become infected with this virtually omnipresent virus, even without treatment, most will not suffer physical harm and as I said above, for persons getting regular sexual health check-ups, there iv very, very little reason for concern.  Having now given my personal perspective, let me try to help with you questions:

1.  I think that clinical clearance (i.e. being able to detect the virus) is common, as we have said in the past, but recent evidence suggests that despite this, the virus is probably present and may occasionally "re-activate" and be shed.  It is probably best to assume that such re-activation is potentially infectious to others.  That said, it remains true that acquisition rates for HPV fall dramatically after age 30 or so suggesting that with some combination of increasing age/exposure/and for some vaccination such shedding does not lead to large numbers of new infections.

2.  See above.  Your analogy to HSV is a good one relative to your question since while HSV viral shedding may occur lifelong, over time the frequency and amount of virus shed diminish. Both frequency and amount of virus present influence the likelihood of infection.

3.  Yes, I think that currently that is a reasonable statement.

4.  Yes, I do think that is a reasonable assumption. Following successful treatment I would not worry about continued transmission.

5.  As Dr. Handsfield has said to you before, I have not examined you and cannot comment with precision to this question but the flat, white spots you describe are certainly not particularly suggestive of HPV and are more likely to represent some other dermatological process.  I would not be worried about htem as HPV from what you say.

I hope these comments are helpful.  EWH
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46 months ago
Hi doctor thank you for your response. You guys are great help for people in my situation. I would appreciate it greatly if you can clarify below questions.

1) If diagnosed and treated, damaging infected cells with cryo and aldara, will it be more likely to clear entirely and more reliably than relying on natural clearance? Can I be confident that 6 months of no recurance after treatment that transmission is unlikely to occur after?

2)Could it be those that unlucky didn't get diagnosed and didnt get treatment thus letting the virus fade away naturally, to be more likely to have a later remergance? and it is natural clearance that now seems les reliable? That treatment can actually help rid of the virus more reliably?

Would you say HPV is more like VZV virus than HSV, where once cleared it may reoccur later in life (old age 50+) like chicken pox that emerges later in life as shingles but not similar to HSV where virus remerging is quite frequent?


Im 25, provided hpv is treated and where symptoms haven't reccured in 6 months or so, that I can move on with confidence that I am not infectious anylonger? That i could maybe expect the virus may reccur at an older age (50 and above) that I am not infectious atleast for the 10-15 years ahead?

Please help me put my mind at ease with your experience and evidence based answers. 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
1.  Most therapies for warts, including cryo are essentially destructive processes and as such it is logical to think that HPV treated in this way may be less likely to recur than natural, immune-mediated clearance.  Obviously there are no such studies but this is a reasonable suggestion.  As for Aldara (imiquimod), this therapy basically generates and inflammatory response which helps to resolve the HPV.  this is a somewhat different approach than destructive therapies like laser, cryo, etc. and more similar to the natural response. Thus, hypothetically and again I EMPHASIZE, with no data, such lesions might recur more.  True estimates of reliability of treatment however are at best, guesses

2.  This is essentially the same question as above. 

You seem to like analogies.  I think you are stretching things trying to figure out if an VZV analogy is "better" than a HSV analogy.  I also think that your persistence in such questions suggests that you are overly anxious about this, out of proportion to what might be in your best interest.  Perhaps you should discuss this anxiety with a counselor.  As best I can tell, you are really not even sure you had HPV.  In the interim and irrespective of whether you seek counseling or not, I would urge you to move on and try to put your concerns about HPV aside.  EWH
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46 months ago
Hi doctor. Thank you for your response. I will reach out to a counselr.
Could you kindly answer this one last question please I want to stop worrying about transmission. 

1)Im 25, provided hpv is treated and where symptoms haven't reccured in 6 months or so, that I can move on with confidence that I am not infectious anylonger? That i could maybe expect the virus may reccur at an older age (50 and above) that I am not infectious atleast for the 10-15 years ahead?

2) I uploaded a clear picture of initial spots I had that doctors diagnosed at warts, in srilanka not many std experts are available for me to get a reliable diagnosis, could you kindly as a one of please check the image and tell me if you think these are warts to put my situation to rest? they are pretty accurate as to what it looked like. if you can it would mean a lot to me. 

thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
1.  Having had your lesions (which still are not clearly a manifestation of HPV infection) resolve should give you confidence that you are not going to transmit infection to others in the future.  I would not put an age limit on my suggestion that you be confident about this. 

2.  Sorry, we do not evaluate photographs on this site.  Past experience has proved that such images are misleading and rarely provide information which is helpful to our clients.  If you are concerns, I would suggest you seek evaluation by a reputable dermatologist.

Finally, as I have suggested before, in closing this thread I need to say that I believe you are unnecessarily concerned about the possibility of having or having had HPV in the past.  This is neither medically appropriate nor good for your mental health.  If you are having trouble moving forward from these concerns, my sincere advice, provided out of concern for you and nothing more, is for you to seek help from a trained counselor or mental health professional.  In addition, I would also recommend that you seek to obtain and receive the HPV vaccine which is highly effective and will help prevent future HPV infections.  EWH
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